Radiation Pneumonitis and Change of Pulmonary Function after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer and Their Impact on Survival in a Supplementary Analysis of Japan Clinical Oncology Group (JCOG) Study JCOG0403

E488

International Journal of Radiation Oncology  Biology  Physics

3155

Purpose/Objective(s): Recent reports have identified extent of cardiac irradiation as an important prognostic factor following radiotherapy for non-small cell lung carcinoma (NSCLC). In this report, we jointly investigate the value of metabolic tumor volume (MTV) on FDG-PET and cardiac dosing as predictors of overall survival (OS) following chemoradiotherapy for stage III NSCLC. Materials/Methods: Total MTV (including the primary tumor and hypermetabolic regional lymph nodes) and heart V40Gy values were extracted from pre-treatment PET images and radiotherapy treatment plans of 91 patients with stage III NSCLC and ECOG performance status 0-2 who were treated with definitive chemoradiotherapy at our institution between 2007 and 2016. Univariate and multivariable Cox regression models were used to evaluate MTV and heart V40Gy as predictors of OS following treatment. Kaplan-Meier curves were generated for subgroups of patients sorted by MTV and heart V40Gy. Results: With a median follow-up duration of 26.0 months for surviving patients, 39 deaths have been observed. Median pre-treatment MTV was 52 cc (interquartile range [IQR] 25 to 96 cc), and median heart V40Gy was 10% (IQR 4% to 19%). In univariate Cox models, neither MTV (HRZ1.03 per 10 cc, 95% CI 0.99 to 1.07, pZ0.149) nor heart V40Gy (HRZ1.01, 95% CI 0.99 to 1.03, pZ0.433) were statistically significant predictors of OS. In a multivariable model including an interaction term defined as MTV multiplied by heart V40Gy, the interaction term was statistically significantly associated with OS (pZ0.026), indicating that high values of MTV and heart V40Gy synergistically increase the risk of death. We therefore grouped patients as follows: Group 1 e MTV and heart V40Gy both below the cohort’s median values (nZ24); Group 3 e MTV and heart V40Gy both above the cohort’s median values (nZ23); Group 2 e all other patients (nZ44). Median OS durations were 55.1 months for Group 1, 36.1 months for Group 2, and 24.5 months for Group 3 (Cox model test for trend pZ0.048). Conclusion: We found a synergistic effect between tumor burden and heart V40Gy as predictors of death following chemoradiotherapy for stage III NSCLC. Patients with limited disease burden who can be treated safely can have excellent outcomes. As more effective systemic and local treatments for NSCLC are developed, greater emphasis on minimizing cardiac irradiation may be warranted. Author Disclosure: K. O’Grady: None. S.C. Desai: None. W.R. Bodner: None. S. Kalnicki: Travel Expenses; Varian Oncology Systems. Member of NY State Executive COmmittee; American College of Radiology. M.K. Garg: Speaker’s Bureau; Covidien, Varian. W.A. Tome: Research Grant; Varian Inc.. Honoraria; Varian Inc.. Travel Expenses; Varian Inc.. Royalty; Wisconsin Alumni Research Foundation. Patent/License Fees/Copyright; Wisconsin Alumni Research Foundation. Chair, Co-Chair, and Member of a number of working groups; AAPM. N. Ohri: None.

Patient-Clinician Communication Among Patients With Stage I Lung Cancer: A Prospective Study from an NCI Comprehensive Cancer Center S.M. Nugent,1,2 S. Golden,3 C.R. Thomas Jr,4 and C. Slatore3,5; 1Health Services Research & Development, VA Portland Health Care System, Portland, OR, 2Oregon Health & Science University, Department of Psychiatry, Portland, OR, 3VA Portland Health Care System, Portland, OR, 4 Oregon Health & Science University, Knight Cancer Institute, Portland, OR, 5Oregon Health & Science University, Portland, OR Purpose/Objective(s): A paucity of prospective data exist pertaining to patient-clinician communication and patient-centered outcomes among patients who undergo surgery and stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We herein present baseline data from a prospective, multi-center, mixed-methods, longitudinal study regarding patient-clinician communication for these patients (pts). Materials/Methods: Eligible pts with clinical stage I NSCLC completed a baseline survey, administered after a discussion about treatment options and prior to treatment. The survey assessed sociodemographic characteristics, treatment decision variables, communication quality, and ptcentered outcomes (PCOs) using validated measures: health related quality of life (HRQOL), self-efficacy, decisional conflict, and patient-centered communication (PCC). Semi-structured qualitative interviews were conducted with an additional cohort (n Z 13) of pts to evaluate communication quality and pt treatment satisfaction. Results: Fifty-two percent of 155 individuals who completed the baseline survey opted for SBRT. The average age of the entire sample was 70.6 (SD Z 8.2); the majority were white (92%) and male (68%). Quantitative findings revealed that 86% reported they were “very well informed” about treatment options and over 90% were “very satisfied” with their clinician’s explanation of treatment options. There were no differences in full scale PCOs between participants who opted for surgery or SBRT. Participants reported high baseline levels of HRQOL (M Z 72.5, SD Z 21.3; out of 100), high self-efficacy (M Z 1.5, SD Z 0.5; out of 6), minimal decisional conflict (M Z 15.2, SD Z 12.7; out of 100), and high levels of PCC (M Z 2.4, SD Z 0.8; out of 7). Linear multiple regression analyses, adjusting for sociodemographic and clinical variables, found that higher quality patientclinician communication was associated with better self-efficacy, b Z 0.18, p Z 0.02 and lower decisional conflict, b Z 0.41, p <0.001. Qualitative content analysis revealed high satisfaction with care and communication with their clinician, despite participants’ perceived deficits in clinician’s explanation of treatment options and the associated risks of treatment. Conclusion: Participants were generally satisfied with their care, though they could not readily recall information about treatment options or the associated risks of treatment. Moreover, higher-quality communication was associated with higher self-efficacy and lower decisional conflict. Selfefficacy, decisional conflict, and satisfaction with care may influence subsequent health outcomes. Thus, patients may benefit from communication strategies to improve these outcomes. Author Disclosure: S.M. Nugent: None. S. Golden: None. C.R. Thomas: None. C. Slatore: None.

3156 Interaction of Metabolic Tumor Volume and Cardiac Dosing as Predictors of Overall Survival Following Chemoradiation Therapy for Stage III Nonesmall Cell Lung Carcinoma K. O’Grady,1 S.C. Desai,2 W.R. Bodner III,2 S. Kalnicki,3 M.K. Garg,2 W.A. Tome,3 and N. Ohri2; 1Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, 2Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, 3Albert Einstein College of Medicine, Bronx, NY

3157 Radiation Pneumonitis and Change of Pulmonary Function after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer and Their Impact on Survival in a Supplementary Analysis of Japan Clinical Oncology Group (JCOG) Study JCOG0403 H. Onishi,1 Y. Nagata,2 M. Hiraoka,3 M. Wakabayashi,4 J. Eba,5 S. Ishikura,6 M. Kokubo,7 K. Karasawa,8 Y. Shioyama,9 R. Onimaru,10 T. Kozuka,11 E. Kunieda,12 T. Saito,13 K. Nakagawa,14 M. Hareyama,15 Y. Takai,16 K. Hayakawa,17 and N. Mitsuhashi18; 1University of Yamanashi, Yamanashi, Japan, 2Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan, 3Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan, 4National Cancer Center Japan, Tokyo, Japan, 5 National Cancer Canter Japan, Tokyo, Japan, 6Department of Radiology, Koshigaya Municipal Hospital, Koshigaya, Japan, 7Division of Radiation Oncology, Department of Image-based Medicine, Institute of Biomedical Research and Innovation Hospital, Kobe, Japan, 8Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22, Bunkyo-ku, Tokyo, Japan, 9Ion Beam Therapy Center, SAGA HIMAT

Volume 99  Number 2S  Supplement 2017 Foundation, Tosu, Japan, 10Hokkaido University Graduate School of Medicine, Sapporo, Japan, 11The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo 135-8550, Japan, 12Tokai University, Kanagawa 259-1193, Japan, 13Sonodakai Radiation Oncology Clinic, Adachi, Japan, 14Department of Radiology, the University of Tokyo Hospital, Tokyo, Japan, 15Sapporo Medical University, Sapporo, Japan, 16 Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Japan, 17Kitasato University, Kanagawa, Japan, 18 Hitachinaka General Hospital, Hitachinaka, Japan Purpose/Objective(s): The purpose of this study was to investigate the frequency of radiation pneumonitis and change of pulmonary function and their impact on survival after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403. Materials/Methods: Radiation pneumonitis was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0. The test of pulmonary function included forced expiratory volume in 1.0 second (FEV1.0) and oxygen saturation of peripheral artery (SpO2). These were measured before the start of SBRT and every 6 months after it. In a total of 169 pts (65 medically operable and 104 inoperable; median age,78) enrolled in the phase II study of SBRT with 48Gy in 4 fractions for T1N0M0 pathology-proven NSCLC (JCOG0403), 146 pts and 153 pts whose FEV1.0 and SpO2 were measured before the start of SBRT and at least once after the start of SBRT without events that might affect their pulmonary function, such as local recurrence, regional lymph node metastases, or lung metastases were included in the analysis of FEV1.0 and in the analysis of SpO2, respectively. The worst grade of radiation pneumonitis and the maximum change of pulmonary function were determined based on each record during the first 1 year after the start of SBRT. Hazard ratios (HR) and their 95% confidence intervals (CI) for overall survival (OS) between subgroups were estimated by the Cox proportional hazards model and the landmark analysis was applied to OS counted from 1 year and 30 days after the start of SBRT. Results: Radiation pneumonitis grade 2 or more was observed in 33 (20%) of 169 pts, 14 (22%) of 65 inoperable pts, and 19 (18%) of 104 operable pts. The pts with the factor of older age or tumor located in the middle or lower lobe had grade 2 or more radiation pneumonitis more frequently in the total of 169 pts (Fisher’s exact test pZ0.033, pZ0.048). FEV1.0 was decreased by 10% or more in 46 (32%) in total, 18 (32%) of inoperable pts, and 28 (32%) of operable pts. Larger tumor size was associated with 10% or more decrease of FEV1.0 in the total pts (pZ0.010) and inoperable pts (pZ0.016). Absolute % of SpO2 decreased by 5% or more in 5 (3%) of the total of 153 pts, 2 (3%) of 59 inoperable pts, and 3 (3%) of 94 operable pts. Grade 2 or more radiation pneumonitis and 10% or more decrease of FEV1.0 were not associated with OS in any groups, but 5% or more absolute % of SpO2 decrease was a worse factor for OS in the total pts (HR Z 3.28: 95%CI, 1.31-8.20, log-rank test pZ0.007) and inoperable pts (3.63: 95%CI, 1.10-11.94, pZ0.023). Conclusion: The study suggested that more attention should be paid in the pts with the factor of older age, and tumor located in the middle or lower lobe for radiation pneumonitis, and the pts with larger tumor size for deteriorating pulmonary function. Decrease of absolute % of SpO2 5% or more might be a poor prognostic factor. Author Disclosure: H. Onishi: None. Y. Nagata: None. M. Hiraoka: None. M. Wakabayashi: None. J. Eba: None. S. Ishikura: None. M. Kokubo: None. K. Karasawa: None. Y. Shioyama: None. R. Onimaru: None. T. Kozuka: None. E. Kunieda: None. T. Saito: None. K. Nakagawa: None. M. Hareyama: None. Y. Takai: None. K. Hayakawa: None. N. Mitsuhashi: None.

3158 Clinical Significance of Pretreatment Tumor Growth Rate for Locally Advanced NSCLC B. Osorio,1 C.B. Simone II,2 C. Hadzitheodorou,1 S. Kim,3 D.K. Gaines,1 W. Zou,4 L. Lin,4 J. Malhotra,5 K. Nie,3 J. Aisner,3 and S.K. Jabbour3; 1 Rutgers Cancer Institute of New Jersey, Department of Radiation

Poster Viewing E489 Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, 2University of Maryland Medical Center, Baltimore, MD, 3Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 4Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 5Rutgers University- Robert Wood Johnson Medical School, New Brunswick, NJ Purpose/Objective(s): Non-small cell lung cancer (NSCLC) often demonstrates notable growth before the initiation of treatment. It is currently unknown whether pretreatment growth rates are prognostic for unresectable Stage II-III NSCLC. We hypothesized that pretreatment tumor volume growth rate could help to predict overall survival and recurrence rates in stage II-III NSCLC patients treated with curative intent chemoradiation (CRT). Materials/Methods: Under an IRB approved protocol, patients with Stage II-III NSCLC (nZ42) treated with definitive CRT underwent a baseline diagnostic chest CT scan at diagnosis, followed by a CT simulation scan. Tumor volume mass was calculated on both imaging sets using the radiation treatment planning system (Eclipse, Varian Medical Systems, Milpitas, CA). Specific Growth Rate (SGRZln2/DT) was used to determine the growth of the tumor while being unaffected by uncertainties in measurements of tumor volume and the presence of short time intervals. To calculate SGR, we used the doubling time for the tumor’s growth (DTZ t * ln2/(ln(GTV2/GTV1)). Log-rank tests and univariate Cox regression models were used to quantify differences in OS based on SGR, as well as differences in recurrence based on SGR. Results: Concurrent CRT was administered to a median total dose of 6120 cGy (range 5200-7400 cGy) in 180-200 cGy fractions. Patients were divided into two groups for analysis, those with SGR above the median value of 0.606%/day (high SGR) and those with SGR < 0.606%/day (low SGR). Stratified by SGR was not associated with significantly differences in overall survival (p Z 0.556), recurrences (p Z 0.654), or NSCLC histology (p Z 0.715). SGR as a continuously measured covariate, however, did show an 8% increase in the risk of death for each 0.1%/day increase in SGR (p Z 0.037). Conclusion: A higher pretreatment SGR was correlated with worse outcomes for patients but did not predict patterns of failure or median overall survival. Further study in larger populations may elucidate the value of SGR as a prognostic marker. Author Disclosure: B. Osorio: None. C.B. Simone: ; Annals of Palliative Medicine, Proton Collaborative Group (PCG). C. Hadzitheodorou: None. S. Kim: None. D.K. Gaines: None. W. Zou: None. L. Lin: None. J. Malhotra: None. K. Nie: None. J. Aisner: None. S.K. Jabbour: Research Grant; Merck.

3159 Anemia and Maximum Standardized Uptake Value (SUVmax) as Predictive Factors in Lung Cancers Treated With Stereotactic Body Radiation Therapy R.S. Pathak,1,2 R.M. MacRae,3 G.G. Cook,4 O.E. Holmes,4 P. Cross,3 and J.R. Pantarotto3; 1The Ottawa Hospital, Division of Radiation Oncology, Ottawa, ON, Canada, 2University of Ottawa, Ottawa, ON, Canada, 3University of Ottawa, Division of Radiation Oncology, Ottawa, ON, Canada, 4The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada Background: Stereotactic Radiation Therapy has become standard treatment for medically inoperable early stage lung cancer patients. Salvage for local failure, though rare, is challenging. Hematological parameters are known predictors for local recurrence in advanced malignancies treated with conventional RT. Purpose/Objective(s): To study the role of hematological parameters in NSCLC patients treated with SBRT. Materials/Methods: We reviewed 470 consecutive biopsy-proven stage I NSCLC patients (490 lesions) in an ethics-approved single institution retrospective study. Each patient underwent FDG-PET/CT for staging. Patients received an SBRT regimen with a Biologically Equivalent Dose (BED)> 100 Gy10 from January 2009 to January 2016. 419 patients had a